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Type: Journal article
Title: Vascular access and all-cause mortality: a propensity score analysis
Author: Polkinghorne, K.
McDonald, S.
Atkins, R.
Kerr, P.
Citation: Journal of the American Society of Nephrology, 2004; 15(2):477-486
Publisher: Lippincott Williams & Wilkins
Issue Date: 2004
ISSN: 1046-6673
Abstract: ABSTRACT. The native arteriovenous fistula (AVF) is the preferred vascular access because of its longevity and its lower rates of infection and intervention. Recent studies suggest that the AVF may offer a survival advantage. Because these data were derived from observational studies, they are prone to potential bias. The use of propensity scores offers an additional method to reduce bias resulting from nonrandomized treatment assignment. Adult (age 18 yr or more) patients who commenced hemodialysis in Australia and New Zealand on April 1, 1999, until March 31, 2002, were studied by using the Australian and New Zealand Dialysis and Transplant Association (ANZDATA) Registry. Cox regression was used to determine the effect of access type on total mortality. Propensity scores were calculated and used both as a controlling variable in the multivariable model and to construct matched cohorts. The catheter analysis was stratified by dialysis duration at entry to ANZDATA to satisfy the proportional-hazard assumption. There were 612 deaths in 3749 patients (median follow-up, 1.07 yr). After adjustment for confounding factors and propensity scores, catheter use was predictive of mortality. Patients with arteriovenous grafts (AVG) also had a significantly increased risk of death. Effect estimates were also consistent in the smaller propensity score–matched cohorts. Both AVG and catheter use in incident hemodialysis patients are associated with significant excess of total mortality. Reducing catheter use and increasing the proportion of patients commencing hemodialysis with a mature AVF remain important clinical objectives.
Keywords: Humans
Catheterization, Central Venous
Renal Dialysis
Arteriovenous Shunt, Surgical
Cause of Death
Survival Analysis
ROC Curve
Catheters, Indwelling
Aged, 80 and over
Middle Aged
Description: © 2004 American Society of Nephrology
DOI: 10.1097/01.ASN.0000109668.05157.05
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